Z Gastroenterol 2011; 49 - P5_33
DOI: 10.1055/s-0030-1269739

Pediatric Acute Hepatic Failure: Longer Duration Of Pre-Tertiary Care Is Associated With Increased Risk of Death Staging

E Sturm 1, WS Lexmond 2, HJ Verkade 2
  • 1Universitätsklinikum Tübingen, Klinik für Kinder- und Jugendliche, Gastroenterologie, Tübingen
  • 2University Medical Center Groningen, Beatrix Childrens Hospital, Pediatric Gastroenterology, Groningen, Niederlande

Aims: In pediatric acute liver failure (PALF), rapid transfer to a liver transplantation center (LTC) is advocated for optimal outcome. Aim: To analyze the duration of pre-tertiary care (DPTC) before transfer to a LTC and its effect on outcome predictors and on a risk of death staging system. Methods: Charts of 47 PALF patients were retrospectively reviewed and according to DPTC divided into two cohorts: cohort 1 (n=24) with DPTC <7 days and cohort 2 (n=23) with DPTC ≥ 7 days. Clinical and biochemical parameters were compared using Mann-Whitney U test. Mortality risk staging for PALF was performed using the liver injury units (LIU) score (Liu E, J. Hepatology 2006). Results: The cohorts were comparable with regard to age, sex, etiology, extraregional or regional transfermode overall outcome including mortality and number of patients transplanted. The DPTC was significantly longer in cohort 2 compared to cohort 1: 11.5 vs. 2.0 days (median, p<0.001). The following outcome predictors were different between the cohorts (patient number, cohort 2 vs. 1, all p<0,05): INR >2.55 at admission 21 vs. 14; bilirubin >235 umol/l 22 vs. 12 ; time to onset before encephalopathy >7 days 12 vs. 2. ALAT levels at LTC admission 1144 vs. 2545 U/l (median). The LIU score in cohort 2 was significantly higher than in cohort 1: 246 vs. 156 units (median, p<0,05), indicating a 20% higher risk of death. Conclusion: In children with PALF, DPTC equal or longer than 7 days had a negative effect on clinical and biochemical outcome predictors and was associated with a higher risk of death in the LIU scoring system. Patients should be transferred to an LTC before advanced disease develops. To achieve maximum benefit from early referral, PALF management needs to be improved.

Literatur:

Liu E, MacKenzie T, Dobyns EL, Parikh CR, Karrer FM, Narkewicz MR et al. Characterization of acute liver failure and development of a continuous risk of death staging system in children. J Hepatol 2006;1: 134-141.

acute liver failure - mortality risk